Cervical Intracepthelial Neoplasma (CIN); CIN represents a spectrum of neoplastic changes of the

squamous epithelium of the cervix that have been recognized as precursors of invasive squamous cell
carcinoma. CIN is graded on a scale from I to III, which can also be expressed descriptively as mild,
moderate, or severe dysplasia, or carcinoma in situ. On Pap smear, these lesions are classified by
cytologists as squamous intraepithelial lesions of low or high grade
Precancerous stage
Non invasive
May remain so for up to 20days before becoming invasive [cancerous]
May regress spontaneously
Increase risk of cancer occur with the more severe CIN grade
Associated with HPV(16,18,31,33 serotypes
Also called carcinoma in situ if in CIN 3
Easily treated

CIN classification
Grade 1 mild dysplasia
Grade 2 moderate dysplasia
Grade 3 severe dysplasia [carcinoma in situ]

Another classification
1. Low grade
2. High grade

CIN morphology
 Early lesions resemble condylomata acuminata
 Maybe raised {acuminatum} or macular {flat condyloma}
 Nuclear enlargement { in cells}
 Hyperchromasia in superficial epithelial cells { this shows active viral replication in
maturing cells that is viral cytopathic effect}
  May have koilocytic atypia {nuclear atypia plus perinuclear vacuolation that is
cytoplasmic halos}
 Raised lesions [acuminatum] contain usually low risk HPV
 Flat CIN usually has high risk HPV
Detection
Papanicolau smear
Squamous cell carcinoma
 Age ranges from second decade to old age
 Peak incidence increasing in younger age
 Increasing incidence due to improving screening technique [ papanicolau smear ] and
increased and early sexual activity.
Morphology
Three patterns
1. Fungating [exophytic]
2. Ulcerating
3. Infiltrative

Spread
Contiguity: to peritoneum, urinary bladder, ureter, rectum, and vagina.
Also metastasizes to liver, lung, bone marrow

Types of squamous cell carcinoma: large cell makes up 95% of squamous cell carcinoma.

1. Large cell which can be

a. Keratinizing (well differentiated )
b. Non-keratinizing (moderately differentiated)
2. Neuroendocrine or oat cell carcinoma (small cell undifferentiated carcinoma) –poor prognosis
3. Small cell squamous (poorly differentiated carcinomas)

Staging of Cervical Cancer

Staging

Stage 0: carcinoma in situ (CIN III )

Stage 1: carcinoma confined to cervix.

1a. Preclinical carcinoma diagnosed only by microscopy (microinvasive carcinoma)

1b. Histologically invasive carcinoma confined to cervix (occult carcinoma)

Stage 2: extend beyond cervix but not onto pelvic wall. Involves vagina but not lower third.

Stage 3: extend to pelvic wall. On rectal examination, no cancer free space between tumour and pelvic
wall. Involves lower one-third of vagina.

Stage 4: extend beyond true pelvis or has involved muxosa of bladder or rectum. There is metastasis.

10-25% of cervical cancer are:

1. Adenocarcinomas
2. Adenosquamous carcinomas, undifferentiated carcinoma or other rare types.

Cervical Adenocarcinomas

 Arise (likely) in endocervical glands.

 Often preceeded by CIN(adenocarcinoma in situ).
 One-fifth as common as squamous carcinoma.
 Not associated with HPV type, is unlike squamous cell carcinoma.

Adenosquamous Carcinomas

 Have mixed glandular and squamous patterns.

 Arise from multipotent reserve cells in basal endocervical endothelium.
 Favourable prognosis than squamous cell carcinoma.
 Relation to HPV is unclear.

Management

 Early detection and treatment.

Treatment

Surgery, radiotherapy, chemotherapy and cryotherapy.